KARACHI: As eight-year-old Yusra prepares to rejoin her school after a break of eight months, she has something big in mind: the dream of becoming a doctor.
And, when you in fun point out to her that medical professionals use injections and hurt patients, she remains inflexible in her attitude.
“Yes, sometimes they do use this kind of stuff. But they also make you well,” she insists.
The reason for Yusra’s newfound love for doctors is her memorable experience with a long list of medical experts during her treatment both in Pakistan and India, explain her parents.
The little girl is perhaps the first Pakistani to have liver and kidney transplants together.
The surgery was carried out at Chennai’s Global Hospital, working closely with the Sindh Institute of Urology and Transplantation (SIUT), in June. Her uncle and aunt donated their organs to save her life.
“Liver transplant transforms life. The girl is completely cured now and would hopefully grow up as a normal individual,” remarks Dr Mohamed Rela, consultant liver transplant and surgeon of the Global Hospital who is currently visiting Karachi for a lecture at the SIUT.
Yusra, the only child of Farzana and Javed Akhter Butt, initially had complaints of vomiting and trembling in 2008. Later, she started having fits and was taken to a private hospital. Doctors diagnosed her with renal failure, put her on dialysis and referred her to the SIUT where it was diagnosed that she was suffering from primary hyperoxaluria.
The disease, according to experts, occurs when the liver due to an enzymatic defect produces too much of oxalate — the salt form of oxalic acid present in the urine.
The increased concentrations of oxalate in the body fluids can lead to the deposition of calcium oxalate (oxalosis) in kidney tissues or urinary tract.
Oxalosis occurs after the kidneys fail and the excess oxalate builds up in the blood and then deposits oxalate salts in the eyes, blood vessels, bones, muscles, heart and other major organs. The patients may eventually lose kidney function, depending upon the severity of the disease.
“It’s a very rare metabolic liver disorder and the girl was born with it. Two transplants were required so that the new liver corrects the metabolic defect while the new kidney replaces the lost kidney function,” Dr Rela says, adding that such patients require regular dialysis to remove excess amount of oxalates.
Before surgery, Yusra remained on dialysis for one and a half years; the procedure was carried out thrice a week till January and on a daily basis afterwards.
During the period, she also developed heart and breathing problems. The SIUT suggested the couple to get the transplants done by Dr Rela who had visited the hospital to share his expertise.
“At the SIUT, we have all the facilities for carrying out a cadaver liver transplant. However, the technology for a living donor transplant is more demanding and involves risk,” says Dr Syed Mujahid Hassan, a gastroenterologist and associate professor at the SIUT, while explaining why the transplant couldn’t be carried out at the hospital.
Following the SIUT recommendation, the family launched a campaign to collect money for the transplant. “I am a sub-inspector in the police department and live in police quarters. I could never afford the expenses for the costly treatment.
So we knocked every door to generate money for the purpose,” Mr Butt recalls.
The transplants cost Rs5 million while the post and pre-transplant medications, dialysis and laboratory tests cost more than Rs300,000.
The parents have expressed gratitude to the chief minister, a former provincial health minister and Senator Babur Ghauri for making special efforts for their daughter’s treatment.
Regarding any adverse impact of liver transplant, Dr Rela says that the youngest liver patient he has handled so far was five days. Now the patient is 14 years and very much healthy, he adds.
Regarding the effects of immunosuppressive drugs medications on young patients, he says these drugs used to have long-term negative effects for instance vulnerability to infections and renal impairment, but they have now become a rarity with better understanding of the disease.
Every year 10 to 15 patients travel to India from Pakistan for liver transplants. “We have achieved this stage after a long struggle.
It was 15 years ago that we passed the law on cadaver organ donations and now people have started donating organs. So it will take time in Pakistan also,” he says.
Dr Rela says that only five to six transplants of two organs together have been carried out in India over the past two years.
The Indian law, he adds, doesn’t allow cadaver organ donation for non-locals and taking both organs from one donor will have increased risk for the donor.